ADVANCE VACCINE/TESTING/SCREENING DIRECTIVE
I refuse all vaccines and all COVID-19 related and derivative tests
I do not authorize any person, agency or organization to immunize me in any way. Nor, do I authorize any person, agency, or organization to test or screen me for viruses.
Do not presume, assume, imply or deem my informed consent.
THIS DIRECTIVE SUPERCEDES ANY CONSENT, LIVING WILL, ADVANCE MEDICAL OR HEALTH CARE DIRECTIVE, OR OTHER COMMUNICATION I MAY HAVE MADE OR HEREAFTER MAKE. THIS ADVANCE DIRECTIVE SPEAKS FOR ME AND FOR THOSE I LEGALLY SPEAK, WHETHER OR NOT CONSCIOUS OR COMPETENT.
VIOLATING THIS ADVANCE DIRECTIVE IS A CRIMINAL ACT
The Patient Self-Determination Act (PSDA)
H.R. 4449 – 1990
HR 4449 IH 101st CONGRESS 2d Session H. R. 4449 To amend titles XVIII and XIX of the Social Security Act to require providers of services and health maintenance organizations under the medicare and medicaid programs to assure that individuals receiving services will be given an opportunity to participate in and direct health care decisions affecting themselves. IN THE HOUSE OF REPRESENTATIVES April 3, 1990 Mr. LEVIN of Michigan (for himself, Mr. SWIFT, Mr. MOODY, Mr. MCDERMOTT, and Mr. FAUNTROY) introduced the following bill; which was referred jointly to the Committees on Ways and Means and Energy and Commerce A BILL To amend titles XVIII and XIX of the Social Security Act to require providers of services and health maintenance organizations under the medicare and medicaid programs to assure that individuals receiving services will be given an opportunity to participate in and direct health care decisions affecting themselves. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the `Patient Self Determination Act of 1990'. SEC. 2. MEDICARE PROVIDER AGREEMENTS ASSURING THE IMPLEMENTATION OF A PATIENT'S RIGHT TO PARTICIPATE IN AND DIRECT HEALTH CARE DECISIONS AFFECTING THE PATIENT. (a) IN GENERAL- Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)), as amended by section 6112 of the Omnibus Budget Reconciliation Act of 1989, is amended-- (1) by striking `and' at the end of subparagraph (O), (2) by striking the period at the end of subparagraph (P) and inserting `, and', and (3) by inserting after subparagraph (P) the following new subparagraph: `(Q) in the case of hospitals, skilled nursing facilities, home health agencies, and hospice programs, to maintain written policies and procedures with respect to all individuals receiving medical care by or through the provider-- `(i) to inform such individuals of an individual's rights under State law (whether statutory or as recognized by the courts of the State) to make decisions concerning such medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advanced directives recognized under State law relating to the provision of care when such individuals are incapacitated (such a directive in this subparagraph referred to as an `advanced directive'), such as through-- `(I) the appointment of an agent or surrogate to make health care decisions on behalf of such an individual, and `(II) the provision of written instructions concerning the individual's health care (including instructions for the disposition of organs); `(ii) to inquire periodically (and to document in the individual's medical record) whether or not the individual has executed an advanced directive and to document in such record the individual's wishes (if any) with respect to such medical care; `(iii) not to deny the initial provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advanced directive; `(iv) to ensure that legally valid advanced directives and wishes otherwise documented under clause (ii) are implemented to the extent permissible under State law, including such provisions of State law as relate to the transfer of an individual in the case of a provider which, as a matter of conscience, cannot implement the wishes of the individual; and `(v) to provide (individually or with others) for educational programs for staff, individuals receiving medical care by or through the provider, and the community on ethical issues concerning patient self determination and concerning advance directives respecting such care.'. (b) APPLICATION TO HEALTH MAINTENANCE ORGANIZATIONS- Section 1876(c) of such Act (42 U.S.C. 1395mm(c)) is amended by adding at the end the following new paragraph: `(8) A contract under this section shall provide that the eligible organization shall meet the requirements of section 1866(a)(1)(Q) in the same manner as they apply to hospitals.'. (c) Effective Dates- (1) The amendments made by subsection (a) shall apply with respect to services furnished on or after the first day of the first month beginning more than 180 days after the date of the enactment of this Act. (2) The amendment made by subsection (b) shall apply to contracts under section 1876 of the Social Security Act as of the first day of the first month beginning more than 180 days after the date of the enactment of this Act. SEC. 3. MEDICAID STATE PLANS ASSURING THE IMPLEMENTATION OF A PATIENT'S RIGHT TO PARTICIPATE IN AND DIRECT HEALTH CARE DECISIONS AFFECTING THE PATIENT. (a) IN GENERAL- Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as amended by section 6406(a) of the Omnibus Budget Reconciliation Act of 1989, is amended-- (1) by striking `and' at the end of paragraph (52), (2) by striking the period at the end of paragraph (53) and inserting `; and', and (3) by inserting after paragraph (53) the following new paragraph: `(54) provide that each hospital, nursing facility, home health agency, hospice program, or health maintenance organization receiving funds under the plan shall maintain written policies and procedures with respect to all individuals receiving medical care by or through the provider or organization-- `(A) to inform such individuals of an individual's rights under State law (whether statutory or as recognized by the courts of the State) to make decisions concerning such medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advanced directives recognized under State law relating to the provision of care when such individuals are incapacitated (such a directive in this paragraph referred to as an `advanced directive'), such as through-- `(i) the appointment of an agent or surrogate to make health care decisions on behalf of such an individual, and `(ii) the provision of written instructions concerning the individual's health care (including instructions for the disposition of organs); `(B) to inquire periodically (and to document in the individual's medical record) whether or not the individual has executed an advanced directive and to document in such record the individual's wishes (if any) with respect to such medical care; `(C) not to deny the initial provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advanced directive; `(D) to ensure that legally valid advanced directives and wishes otherwise documented under subparagraph (B) are implemented to the extent permissible under State law, including such provisions of State law as relate to the transfer of an individual in the case of a provider or organization which, as a matter of conscience, cannot implement the wishes of the individual; and `(E) to provide (individually or with others) for educational programs for staff, individuals receiving medical care by or through the provider or organization, and the community on ethical issues concerning patient self determination and concerning advance directives respecting such care.'. (b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply with respect to services furnished on or after the first day of the first month beginning more than 180 days after the date of the enactment of this Act. SEC. 4. STUDY TO ASSESS IMPLEMENTATION OF A PATIENT'S RIGHT TO PARTICIPATE IN AND DIRECT HEALTH CARE DECISIONS AFFECTING THE PATIENT. (a) IN GENERAL- The Secretary of Health and Human Services shall (subject to subsection (b)) enter into an agreement with the Institute of Medicine of the National Academy of Sciences to conduct a study with respect to the implementation of directed health care decisions. Such study shall-- (1) evaluate the experience of practitioners, providers, and government regulators experienced in complying with the requirement imposed by the amendments made by sections 2(a) and 3(a); and (2) investigate methods of making decisions reached by a patient or nursing home resident transferrable, so that the wishes of the patient or resident can be known and respected in other health care settings to which the patient or resident may be transferred or discharged. (b) ARRANGEMENTS FOR STUDY- The Secretary shall request the Institute of Medicine of the National Academy of Sciences to submit an application to conduct the study described in subsection (a). If the Institute submits an acceptable application, the Secretary shall enter into an appropriate arrangement with the Academy for the conduct of the study within 28 days of the date the application is received. If the Institute does not submit an acceptable application to conduct the study, the Secretary may request one or more appropriate nonprofit private entities to submit an application to conduct the study and may enter into an appropriate arrangement for the conduct of the study by the entity which submits the best acceptable application. (c) REPORT- The results of the study shall be reported to Congress and the Secretary by not later than 4 years after the date of the enactment of this Act. Such report shall include such recommendations for legislation as may be appropriate to carry out further the purpose of this Act. SEC. 5. PUBLIC EDUCATION DEMONSTRATION PROJECT. The Secretary of Health and Human Services, no later than 6 months after the date of the enactment of this Act, shall develop and implement a demonstration project in selected States to inform the public of the option to execute advance directives and of a patient's right to participate in and direct health care decisions. The Secretary shall report to Congress on the results of the project and on whether such project should be expanded to cover all the States.
The Right To Have Your Advance Directive Followed
The PSDA requires all healthcare agencies (hospitals, long-term care facilities, and home health agencies) receiving Medicare and Medicaid reimbursement to ask whether you have an advance directive.
Medical care providers are generally held to a pretty strict duty to comply with your recorded wishes that relate to your healthcare if you become incapacitated. In addition, if your healthcare directives or living will appoint someone as a legal agent in charge of your healthcare (called a healthcare agent), doctors and other medical providers are also under a duty to follow their orders and decisions about your care. Advance directives are legally recognized documents; however, there are some situations in which your doctor or medical care provider can go against the wishes that you have set forth in your healthcare directives. Healthcare providers can do so when:
- The directive sets forth decisions that go against the conscience of the doctor or individual medical services provider,
- The directive sets a policy that goes against the policies of the hospital or other medical institution based on reasons of conscience, or
- The directive includes decisions that would result in ineffective healthcare or asks healthcare providers to adopt healthcare standards that violate those of the provider, hospital or other medical institution.
However, even if these factors are present, this does not mean that your doctor or healthcare provider can simply ignore your healthcare directive. Instead, if your doctor or healthcare provider thinks that they will go against the wishes and directions set forth in your healthcare directive, or against the orders of your healthcare agent, they must immediately inform you or your agent. When this happens, you or your agent will have the option of taking steps to have you transferred to another doctor or medical facility where your wishes and instructions will be honored. If your doctor or medical care provider refuses to do so and still goes against your wishes and orders, the doctor may be liable for damages to you.
As more and more healthcare systems consolidate, religiously affiliated hospitals may dominate a region. The policies of these institutions may affect your access to care and whether your stated wishes will be followed. Be sure to ask your doctor or other healthcare providers if your specific advance directive or healthcare wishes will be honored. If not, you have the right to change doctors, pharmacists, hospitals, or any other providers.